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  1. Ngadimon IW, Mohan D, Shaikh MF, Khoo CS, Tan HJ, Chamhuri NS, et al.
    Epilepsia, 2024 Jul;65(7):1962-1974.
    PMID: 38752783 DOI: 10.1111/epi.18007
    OBJECTIVE: Posttraumatic epilepsy (PTE) significantly impacts morbidity and mortality, yet local PTE data remain scarce. In addition, there is a lack of evidence on cognitive comorbidity in individuals with PTE in the literature. We sought to identify potential PTE predictors and evaluate cognitive comorbidity in patients with PTE.

    METHODS: A 2-year retrospective cohort study was employed, in which adults with a history of admission for traumatic brain injury (TBI) in 2019 and 2020 were contacted. Three hundred one individuals agreed to participate, with a median follow-up time of 30.75 months. The development of epilepsy was ascertained using a validated tool and confirmed by our neurologists during visits. Clinical psychologists assessed the patients' cognitive performance.

    RESULTS: The 2-year cumulative incidence of PTE was 9.3% (95% confidence interval [CI] 5.9-12.7). The significant predictors of PTE were identified as a previous history of brain injury [hazard ratio [HR] 4.025, p = .021], and intraparenchymal hemorrhage (HR: 2.291, p = .036), after adjusting for other confounders. TBI patients with PTE performed significantly worse on the total ACE-III cognitive test (73.5 vs 87.0, p = .018), CTMT (27.5 vs 33.0, p = .044), and PSI (74.0 vs 86.0, p = .006) than TBI patients without PTE. A significantly higher percentage of individuals in the PTE group had cognitive impairment, compared to the non-PTE group based on ACE-III (53.6% vs 46.4%, p = .001) and PSI (70% vs 31.7%, p = .005) scores at 2 years post-TBI follow-up.

    SIGNIFICANCE: This study emphasizes the link between TBI and PTE and the chance of developing cognitive impairment in the future. Clinicians can target interventions to prevent PTE by identifying specific predictors, which helps them make care decisions and develop therapies to improve patients' quality of life.

  2. Ngadimon IW, Mohan D, Shaikh MF, Khoo CS, Tan HJ, Lee YM, et al.
    Epilepsia Open, 2025 Feb 12.
    PMID: 39937590 DOI: 10.1002/epi4.70001
    OBJECTIVE: Posttraumatic epilepsy (PTE) and cognitive impairment are severe complications following traumatic brain injury (TBI). Neuroinflammation likely contributes, but the role of specific inflammatory mediators requires clarification. High-mobility group box 1 (HMGB1) is an inflammatory cytokine released after brain injury that may be involved. This prospective longitudinal study investigated whether serum HMGB1 levels are associated with PTE development and cognitive decline over 12 months post-TBI.

    METHODS: Serum samples were collected from 41 TBI patients, including mild and moderate to severe, at baseline, 6, and 12 months following TBI. HMGB1 was quantified by ELISA alongside interleukin-1β (IL-1β) and tumor necrosis factor (TNF). Cognitive assessments using validated neuropsychological assessments were performed at 6 and 12 months. The occurrence of PTE was also tracked.

    RESULTS: HMGB1 remained elevated at 12 months post-TBI only in the subgroup (n = 6) that developed PTE (p = 0.026). PTE was associated with moderate to severe TBI cases. Higher HMGB1 levels at 12 months correlated with a greater decline in Addenbrooke's Cognitive Examination scores (p 

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